Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

23. Mesh Removal for Chronic Pain…
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Noninvasive Options
For nonsevere or acute pain following inguinal hernia repair, the
initial treatment is rest, ice, and/or heat to the groin, anti- inflammatory
medication, and sometimes a mild narcotic medication. This strategy is
appropriate to try for several weeks unless pain is severe or significantly
worsens within a short period of time, despite conservative
treatment.
Once chronic pain develops, other medications that may be considered
include antidepressants, serotonin, and norepinephrine reuptake
inhibitors (SNRIs), neuroleptics, antispasmodics, muscle relaxants,
corticosteroids, anticonvulsants, topical local anesthetics, alpha-adrenergic
agonists, and increased opioid narcotic doses. The use of these medications
to attempt to treat chronic pain and allow a patient to return to
most normal activities may require activity restrictions while the patient
is experiencing chronic pain.
Other noninvasive options include physical therapy and transcutaneous
electrical neural stimulation (TENS) . A TENS unit works by stimulating
large epicritic afferent fibers that sense variations in temperature
and touch. Stimulation of these larger fibers outcompetes and potentially
causes complete conduction block of the afferent signal from smaller
pain fibers.
TENS is thought to produce analgesia by stimulating large afferent
fibers. It may have a role for patients with mild to moderate acute pain
and those with chronic low back pain, arthritis, and neuropathic pain.
The gate theory of pain processing suggests that the afferent input
from large epicritic fibers competes with that from the smaller pain
fibers.
Although evidence in support of complementary alternative medicine
(CAM) for treatment of chronic groin pain is not conclusive, it may
be a useful adjunct to traditional approaches in certain patients. CAM
may include acupuncture, spinal manipulation, massage therapy, relaxation
techniques, tai chi, yoga, and herbal supplements.
To obtain optimal treatment success, psychological, emotional, spiritual,
and family counseling may also be required to address the psychosocial
factors that may have contributed to the development of chronic
pain or may be a result of the enormous toll that chronic pain can exact
on a person’s life, especially when it has been present for a long period
of time.